Provider Demographics
NPI:1184465684
Name:BLOOM HOLISTIC BODYWORK
Entity type:Organization
Organization Name:BLOOM HOLISTIC BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:919-780-4188
Mailing Address - Street 1:1100 OPEN FIELD DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6809
Mailing Address - Country:US
Mailing Address - Phone:919-780-4188
Mailing Address - Fax:
Practice Address - Street 1:1215 JONES FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-5440
Practice Address - Country:US
Practice Address - Phone:919-780-4188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty